Dream-driven, Data-assisted

So look, the stuff we talk about on the main site is all real. We believe in it, or we wouldn’t put it up. But the reality of marketing is that most people don’t want to read a lot of words, so we put our real philosophy into pretty words and make it aspirational so it sounds appealing.

And it really is real, it’s not bullshit. RiverRock is founded on a truly different vision of health, and that vision is expressed in an algorithmic approach to finding the Root Causes that are blocking progress. We truly believe that the core value of RiverRock is in this perspective, because that perspective motivates all the things we do.

But at the same time, that perspective is intended as a practical philosophy, not a “pie in the sky” philosophy. The philosophy is worthless if it doesn’t make us do things differently at RiverRock. It must have real-word, bread-and-butter, feet-on-the-treadmill consequences for how we end up practicing medicine.

So, we wanted to take some space here to talk about those practical effects. It gets a bit long, and kinda technical, and maybe a bit boring for the non-technically inclined, so this page got hidden here for those of you who (like us) are determined and analytic enough to be interested. Btw, if you end up reading this all the way through, even if you disagree with it, we can be 95% sure you’d be a great fit - you should sign up ;).

So, the most obvious differences, practically speaking, can be seen in the first three visits. I have a checklist that I use with my new patients, to get them onboarded with us during their first 3 visits. It's probably changed since I wrote this, but right now, this is the overview.

In the first visit:

If the online consent forms haven’t already been signed, we get those done.

We talk about immediate symptoms, concerns, problems, and issues

We get a complete medical history - I encourage patients to bring any medical records they have, I scan them, and (after they leave) I read every last word.

We complete a thorough physical exam.

We get a baseline EKG and echocardiogram. This has very little immediate value, but if the patient ever has a heart problem, it can be incredibly useful to look back at old EKGs and echos to determine what has changed.

We get a complete set of fasting bloodwork, which is more thorough than the usual: NMR lipids (lipoprofile or similar), which provides MUCH better information than the standard “cholesterol levels” (which, imo, are nearly meaningless). We get STD testing on everyone. We check chemistries and blood counts, with iron levels, and we check insulin sensitivity with an A1c and a HOMA-IR. We also get a Vitamin D, B12, and TSH level.

We also complete a screening analysis using the USPSTF recommendations - this includes all standard screening tests, like mammograms, PAP smears, colonoscopies, vaccines, etc. etc. If you need anything, we’ll let you know and order the necessary tests/vaccines.

We calculate your 10 year cardiac risk using two different methods - Sheffield tables, and the ASCVD heart score. We use the former because it was published before Big Pharma’s influence started, and has been very accurate and useful for many years; we use the second (even though it usually overestimates risk) because it’s the most recent method published.

In the second visit:

We explore your dreams, goals, motivations, beliefs, and health interests.

We evaluate your current diet, exercise regimen, sleep habits, etc.

We prescribe a continuous glucose monitor for at least 2 weeks, to get your basic glucose profile.

We order a cognitive performance online test that you can take at home, so you have a baseline performance level for the future.

After you leave, we complete the RiverRock root cause analysis, to determine what the main obstacles are that you should work on first, and email you our analysis and recommendations.

May not sound like much, but it usually takes up the full hour.

In the third visit:

We get you set up with your RiverRock account, on your phone and computer.

We install the RiverRock app on your phone and go through its capabilities

We provide you with a WHOOP band, prepaid for 6 months of sleep and activity tracking.

We get a complete cardio/pulmonary/metabolic profile, including spirometry, VO2Max, FatMax, and RMR.

We then arrange for quarterly followup visits (or more often, if needed), so that we can stay on track.

Now, all of that is governed by the philosophy of dream-driven healthcare. Figuring out our patients’ dreams, goals, and targets, then analyzing what the most immediate obstacles are, and how to remove those obstacles, and collecting a practical, useful set of data to guide our recommendations.

At the end of these visits, we have quite a lot of data - we have a fantastic activity tracker, sleep tracker, and metabolic profile, all PERSONALIZED to you. We have a baseline set of labs, EKG, cognitive function test, and echocardiogram. We have 2 weeks of continuous glucose monitoring.

THEN, using our knowledge of the patient’s goals, and our gathered data, we can make recommendations.

We usually recommend that our patients try at least a 48-72 hour water fast sometime in the first two weeks. This is frankly fantastic for longevity, but it also provides a great set of glucose data as a baseline.

We often recommend various methods to improve sleep - whether that’s alcohol reduction, or the Doodow device, or (most commonly) blue-light reduction.

We often recommend certain types of exercise, based on your metabolic profile, and what types of exercise will give you the best “bang for your buck” in reaching your dreams. We also make diet recommendations along the same lines (or you can enroll in one of our partners’ diet programs if that suits you better, we can refer you to our favorites).

We almost always have a book or two to recommend, targeted to improve your most pressing obstacle.

So yes, we’re dream-driven, no question. We use the Root Cause Analysis to help structure our thoughts and provide guidance. But we also use data gathering, at a far more advanced level than most medical practices, to personalize and target our recommendations.

In other words, for the marketing, we’re Dream-Driven, Data-Assisted.

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